Access to the disc space between the L4 and L5 vertebrae can be obstructed or difficult due to anatomical considerations. For example, an anterior approach or an anterior oblique approach requires the surgeon to retract or move, or at least work adjacent to, the major vessels extending along the anterior portion of the spinal column. While an anterior oblique approach may reduce or eliminate the requirement for retraction of these major vessels, access for positioning instruments and implants in the posterior portion of the disc space on the side of the approach can be limited. Further, the instruments can still be adjacent the major vessels during the surgery.
A lateral approach to the disc space anterior of the posterior elements can avoid the major vessels and provide access for disc space preparation and implant insertion, but other anatomical obstructions can be encountered. For example, positioning instruments and implants in the spinal disc space between the L4 and L5 vertebrae from an anterior lateral approach can be obstructed or inhibited by the iliac crest. Instrumentation and methods which facilitate placement of implants in the spinal disc space from an anterior lateral approach are needed to make such procedures a more viable alternative for treatment and correction of spinal deformities.